剖宫产率上升原因分析

Analysis of Increasing Cesarean Section Rate From 1995 to 2009

目的通过分析本院1995年至2009年15年间剖宫产率上升情况,探讨新生儿出生体重与剖宫产率变化的关系及剖宫产率与新生儿预后的关系。方法回顾性分析本院1995年1月至2009年12月15年间于本院住院分娩产妇9478例为研究对象,其中剖宫产为3480例,剖宫产率为36.72%。采用统计学方法分析新生儿出生体重、窒息率、病死率与剖宫产的关系(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准)。结果①15年间剖宫产率呈逐年上升趋势,由1995年至1999年的23.34%上升至2005年至2009年的43.56%,且差异有统计学意义(χ2=46.28,P<0.01)。②15年间新生儿平均出生体重维持于约3500g。③巨大儿(出生体重>4000g)在新生儿中的比例维持于约18%,但巨大儿剖宫产率由1995年至1999年间的25.55%增至2005年至2009年间的67.93%,且差异有统计学意义(χ2=54.27,P<0.01)。④15年间,新生儿窒息率由3.84%降至0.37%,且差异有统计学意义(χ2=104.3,P<0.01)。结论做好孕期营养指导,降低新生儿平均出生体重,有望降低剖宫产率。新生儿平均出生体重在3500g的水平上,剖宫产率约为40%可获得较佳母儿结局。

Objective To investigate the status of increase of cesarean section rate and discuss the relationship among cesarean section rate,birth weight and newborns prognosis.Methods From January 1995 to December 2009,a total of 9478 cases of pregnant women delivered in Yantai Ecnomic and Technological Development Zone Hospital were studied retrospectively.Informed consent was obtained from all participates.Neonatal weight,neonatal asphyxia rate,neonatal mortality and cesarean section rate were performed among the year of 1995-1999,2000-2004 and 2005-2009.Results ① The tendency during those 15years showed that the cesarean section rate went steadily up,it was significantly higher in the year of 2005-2009 （ 43.56% ） than that in 1995-1999 （ 23.34% ）（ χ 2 =46.28,P0.01 ） .② Neonatal average weight was stable in the past 15 years,it was about 3500g.③ The proportion of fetal macrosomia （ birth weight4000g ） stabilized in 18% or so in the past 15 years,but the cesarean section rate changed significantly from 25.55% （ 1995-1999 ） to 67.93% （ 2005-2009 ）（ χ 2 =54.27,P0.01 ） .④ Combining with the higher cesarean section rate,the neonatal asphyxia rate decreased significantly from 3.84% to 0.37% （ χ 2 =104.3,P0.01 ） .Conclusions If the pregnant women got a reasonable nutritious instruction,the neonatal weight and the cesarean section rate will be decreased.The best prognosis of neonates that weight 3500g or so was closely related with 40% cesarean section rate.